| NPI | 1972651222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 24083) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03228394) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2018-04-09 |